Summary

An eating disorder, characterized by severe preoccupation about weight and body shape. Includes recurrent episodes of binge eating with compensatory mechanisms, such as self-induced vomiting to prevent weight gain.

Most common in women in their 20s and 30s.

Patients usually appear physically normal, although they may have low self-esteem and depressive thoughts, as well as lack of confidence.

Parotid hypertrophy and erosion of the teeth are the most common physical signs and may prompt diagnosis.

Cognitive behavioral therapy (CBT) is considered optimal primary treatment for bulimia, but is often unavailable.

Selective serotonin-reuptake inhibitors (SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) may also be used adjunctively to CBT, or as an alternative when CBT is not available. Interpersonal psychotherapy (IPT) and dialectical behavioral therapy (DBT) can be used as primary therapy, although less evidence supports their effectiveness.

Treatment of comorbid psychiatric disorders, such as major depressive disorder and OCD, is necessary to optimize the chance of recovery from bulimia nervosa. SSRIs are effective in additional treatment of comorbid psychiatric disease.

Definition

Bulimia nervosa is an eating disorder characterized by recurrent episodes of binge eating, followed by behaviors aimed at compensating for the binge. Binge-eating episodes are characterized by eating an amount of food that is definitely larger than most people would eat (e.g., at least twice the normal amount of food ingested) over a discrete period of time (it must be ingested more quickly than normally). Binges are accompanied by a sense of lack of control over eating during the episode. Recurrent inappropriate compensatory behaviors occur in order to prevent weight gain. These behaviors include self-induced vomiting; fasting; excessive exercise; and misuse of laxatives, diuretics, enemas, or other medication. Binge-eating episodes typically occur, on average, at least weekly for 3 months.
[1]American Psychiatric Association. Diagnostic and statistical manual of mental disorders, 5th ed., (DSM-5). Washington, DC: American Psychiatric Publishing; 2013.

Disclosures

Dr Debra L. Safer would like to gratefully acknowledge Dr David C.W. Lau and Dr C. Laird Birmingham, the previous contributors to this monograph. DCWL declares that he has no competing interests. CLB is an author of several references cited in this monograph.